Page 18 - Journal of Laparoscopic Surgery

WJOLS

Sumanta Kumar Ghosh 10.5005/jp-journals-10033-1211
OriginaL articLe

A Comparative Randomized Parallel Group Study between

the Classical TAPP Repair and Modified TAPP Surgical
Method for Inguinal Hernia Repair

Sumanta Kumar Ghosh

ABSTRACT and Modified TAPP Surgical Method for Inguinal Hernia Repair.
World J Lap Surg 2014;7(1):16-22.
Objective: To compare equality of clinical outcome of simulta-
neous bilateral transabdominal preperitoneal (TAPP) repair of Source of support: Nil
inguinal hernia by classical TAPP, with meticulous closure of Conflict of interest: None
peritoneal flap and modified TAPP, with peritoneal nonclosure
and controlled release of pneumoperitoneum. Study to answer
the research question—‘is meticulous closure of peritoneal InTRoduCTIon
flap, the only way to provide adequate cover for the mesh in
TAPP repair?’ Gall stone disease and inguinal hernia are two most common
surgical problems amenable to laparoscopic surgery but the
Summary and background data: The objective of meticulous
closure of peritoneum is to prevent internal herniation while acceptance and spread of laparoscopic inguinal hernia repair
covering the mesh adequately to avoid contact between mesh (LIHR) is significantly less than laparoscopic cholecystectomy
and abdominal viscera. The study proposes same objective can (LC). Even today, only 15 to 20% of hernia repairs are done
also be achieved with nonclosure of peritoneum. laparoscopically in America. Two factors limiting its accep-
Patients and methods: Between August 2011 and July 2012, tability among patients and surgeons are: stiffer learning
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130 inguinal hernias of 65 patients who underwent TAPP repair curve for surgeons and cost associated with LIHR. Without
were randomized in two groups. One group (n = 65) of hernias aversion for use of modern technology, efforts to simplify
received classical repair with peritoneal closure (control), while
the other (n = 65) without closure (study). The primary end points the technique should be made by sparing the use of costly
were bowel related complications and recurrence. disposable equipment, when possible, without compromising
safety and efficacy of the procedure. This should make it cost
Results: The two groups were comparable in age and types
of hernia. Transabdominal preperitoneal was successfully done effective and acceptable. Increased cost in LIHR is due to
in all cases. No bowel-related complication and recurrence use of disposable equipment like hernia staple or tack and
occurred in either group. Mean operating time was significantly longer operating time. Honing little extra skill and avoiding
less with modified TAPP (65 mins vs 76 mins, p < 0.05). Lower unnecessary use of gadgets make the procedure shorter and
incidence of chronic pain (3 vs 13.84%, p = 0.007) and seroma
(7.69 vs 15.38%) was achieved during mean follow-up of cost effective. It is the cost and technology dependence
628 days. that has overshadowed the obvious benefits of LIHR, like
Conclusion: The randomized prospective parallel group study shorter convalescence, equivalent efficacy, and early return
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demonstrated equality in clinical outcome on both primary end to work. This trial is intended to answer the research
points by providing equivalent peritoneal cover for the mesh as question: ‘is meticulous closure of peritoneal flap, the only
meticulous peritoneal closure does in classical TAPP. way to provide adequate cover for the mesh in TAPP repair?’
Keywords: Laparoscopic repair, inguinal hernia, Preperitoneal, The study focuses on an alternate concept of functional
Transperitoneal, Complication, intestinal. closure of peritoneum, required to cover the prosthesis to
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How to cite this article: Ghosh SK. A Comparative Rando- avoid adhesion and internal herniation, adhesion being
mized Parallel Group Study between the Classical TAPP Repair the precursor of unacceptable postoperative complications
like intestinal obstruction and fistulisation. It scientifically
Professor and Head compares the clinical outcome of the modified technique
Department of Surgery, ESiC Medical College and Post- of absolute nonclosure of peritoneal flap, which is only
graduate Institute of Medical Research, Joka, Kolkata, West made larger and simply relaid in position with controlled
Bengal, india
DE insufflations abdominal viscera gliding along posterior
Corresponding Author: Sumanta Kumar Ghosh, Professor
and Head, Department of Surgery, 3B RM Mullick Garden wall presses the flap sequentially from below upward against
Lane, Manikarn Apartment, Flat-6EB, Kolkata-700010, West the anterior abdominal wall where the repair is done and
Bengal, india, Phone: 9831103370, e-mail: sumantaghosh@ flap was initially harvested from, effectively covering the
hotmail.com
prosthesis and does exactly what meticulous closure do in
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